Minimally Invasive Right Thoracotomy Versus Median Sternotomy for Atrial and Ventricular Septal Defect Closure: A...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Procedures

Background:

• Minimally invasive cardiac surgery (MICS) aims to decrease surgical trauma.
• Limited evidence compares minimally invasive right thoracotomy to conventional median sternotomy for septal defect closure in large cohorts.
• This study addresses the evidence gap for atrial septal defect (ASD) and ventricular septal defect (VSD) repair.

Purpose of the Study:

• To compare perioperative and short-term outcomes of minimally invasive right thoracotomy versus median sternotomy for ASD and VSD closure.
• To evaluate the safety and efficacy of these two surgical approaches.
• To identify potential complications associated with each method.

Main Methods:

• Retrospective analysis of 527 consecutive patients undergoing ASD or VSD closure.
• Stratification into minimally invasive surgery (MIS) and median sternotomy (MS) groups.
• Propensity score matching (1:1) to create 79 comparable pairs based on key patient characteristics and comorbidities.

Main Results:

• No perioperative mortality in either group.
• MIS group showed significantly shorter ICU stay (2.0 vs 3.0 days) and reduced mechanical ventilation duration (7.5 vs 11.4 hours).
• Higher rates of diaphragm paralysis and pneumothorax in MIS; higher rates of pleural effusion, chylothorax, pericardial effusion, and prolonged ventilation in MS.

Conclusions:

• Minimally invasive right thoracotomy is a viable alternative to median sternotomy for septal defect closure, reducing ICU stay and ventilation time.
• Higher rates of phrenic nerve injury and pneumothorax with thoracotomy necessitate careful patient selection and surgical technique.
• This approach is safe and reproducible in experienced centers, offering comparable short-term outcomes.